Oral Health Intervention for Intellectually/Developmentally Disabled Persons

描述(由申请人提供)：居住在家庭或集体之家的智力和/或发育障碍(IDD)患者与居住在机构中的患者相比，获得的预防性医疗护理较少，也不太可能接受常规的牙科护理。与普通人群相比，这些人更有可能有糟糕的口腔卫生、更多的龋齿和牙周病--这是一个显著的健康差距。更重要的是，IDD患者口腔健康状况不佳也可能导致呼吸道感染，包括吸入性肺炎。这一群体的口腔健康不仅因为缺乏每六个月一次的预防性牙科治疗而受到损害，而且由于他们无法充分刷牙和/或用牙线清洁自己的牙齿而受到损害。许多中度到深度残疾的人依赖他们的照顾者来维持口腔健康，但有证据表明，照顾者的心理社会因素是最佳口腔卫生行为的障碍。拟议的口腔健康规划拨款与进行一项为期五年的随机对照试验相结合，由病例经理提供基于口腔健康理论的干预措施。这项研究将通过使用经验性扎根的理论框架、完善的干预策略、更大的样本量以及试点测试过程和结果衡量标准，将先前的试点研究结果扩展到不同的人群。U01合作协议试验将是第一项适当授权的结果研究，以评估牙科病例管理战略对124个社区团体之家的照顾者和IDD参与者的口腔健康、相关生活质量和呼吸道感染的影响。这笔为期两年的规划赠款被要求用于试验招募战略、干预措施的可接受性、保真度监测方法以及研究措施的有效性和可靠性，包括干预过程、调解人、主持人和结果。试点将在25个团体之家的照顾者中进行，大约有112名IDD参与者。规划拨款完成后，将为临床试验(U01合作协议)拨款申请制定一份完整的方案和操作手册。路易斯维尔大学和太平洋研究与评价研究所的工作人员将参加这些活动。这项研究的结果将通过论证牙科病例管理是否改善IDD患者的口腔健康和相关的生活质量，从而影响社会和行为研究领域。如果结果是肯定的，我们将倡导进行更大规模的多点随机对照试验，以产生可推广到不同地理区域口腔健康差异的不同人群的结果。最终，结果可能会影响医疗改革，并将牙科病例管理整合到针对弱势群体的医疗病例管理中。

DESCRIPTION (provided by applicant): People with intellectual and/or developmental disabilities (IDD) living in family or group homes receive less preventive medical care than those living in institutions and are less likely to receive routine dental care. These individuals are more likely to have poor oral hygiene, increased decay, and periodontal disease than the general population-a significant health disparity. More importantly, poor oral health in persons with IDD may also contribute to respiratory infections including aspiration pneumonia. The oral health of this population is compromised not only by the lack of preventive dental treatment every six months but also their inability to adequately brush and/or floss their own teeth. Many of the moderately to profoundly disabled are dependent on their caregivers to maintain oral health but there is evidence that caregiver psychosocial factors serve as barriers to optimal oral hygiene behavior The proposed oral health planning grant is in conjunction with conducting a five-year randomized controlled trial with an oral health theory-based intervention delivered by case managers. The research will extend previous findings from a pilot study to a different population by using an empirical grounded theoretical framework, refined intervention strategy, larger sample size and pilot tested process and outcome measures. The U01 cooperative agreement trial would be the first outcome study properly powered to evaluate the effect of a dental case management strategy on oral health, related quality of life, and respiratory infections with caregivers and IDD participants in 124 community group homes. The two-year planning grant is requested to pilot test recruitment strategies, acceptability of the intervention, fidelity monitoring methods, and validity and reliability of study measures including intervention processes, mediators, moderators, and outcomes. The pilot will be conducted with a sample of caregivers in 25 group homes, with approximately 112 IDD participants. Upon completion of the planning grant, a full protocol and manual of operations will have been developed for the clinical trial (U01 cooperative agreement) grant application. Personnel from the University of Louisville and the Pacific Institute for Research and Evaluation will participate in these activities. The results of this study will impact the field of social and behavioral research by demonstrating whether dental case management improves the oral health and related quality of life of persons with IDD. If the results are positive, we would advocate for a larger multi-site randomized controlled trial to produce results that may be generalized to different populations with oral health disparities in diverse geographic areas. Ultimately, the results could impact healthcare reform and integrate dental case management into medical case management for disadvantaged persons.